Snyder, lawmakers discussing health care exchange

TRAVERSE CITY (AP) -- Gov. Rick Snyder and legislative leaders are still discussing whether to establish a state market where people without health insurance could shop for private policies, officials said Tuesday.

Under President Barack Obama's health care law, states have the option of running their own programs, letting the federal government do it or creating a partnership. The U.S. Department of Health and Human Services wants to hear by Friday from states planning to operate exchanges.

Snyder prefers the state option, which the Michigan Senate has endorsed. But the House declined to vote before last week's election because its Republican majority opposes the Obama plan.

Now that Obama has won a second term, "Obamacare is the law of the land" and a decision must be made about what type of exchange Michigan will have, said Rep. Gail Haines, chairwoman of the House Health Policy Committee.

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Snyder's office said last week it was likely Michigan would opt for a state-federal partnership. That would allow states to handle consumer relations and oversight of health plans while the federal government handles such tasks as enrollment and determining the levels of taxpayer help available to consumers.

But that was partly because the federal government had wanted states planning their own exchanges to provide blueprints of how they would operate by this Friday. HHS Secretary Kathleen Sebelius has since announced that states will have until Dec. 14 to submit those details. The only requirement for this week is to signal their intent to run state exchanges.

"We're trying to determine whether it's possible to do the state exchange," said Geralyn Lasher, a spokeswoman for Snyder. "It's still something we are looking at. There are people who will be sitting up late nights this week trying to figure that out."

Having a state exchange would require legislative authorization and funding. With the Legislature in recess until a lame-duck session begins Nov. 27, its leaders and the governor's staff are discussing whether there will be time then to act on the health care exchange.

Michigan could inform Sebelius that it plans to set up an exchange but change its mind later if necessary, Lasher said. States choosing the partnership route have until mid-February to make a decision and submit their plans.

House Speaker Jase Bolger, who is taking part in talks between legislative leaders, Snyder and his aides, said he was still studying which market system would be best but was not "eager to hand the keys of the state over to the federal government."

"I want to do what is right for Michigan patients," said Bolger, a Republican from Marshall. "What we're evaluating right now is what each of those options would mean to patients and their doctors, and what they would mean to Michigan citizens' ability to control their health care."

The exchange would provide a website where individuals and small businesses could compare available health policies. More than 500,000 Michigan residents are expected to buy private insurance through the exchange, which is supposed to begin operating in 2014. Nearly 1.3 million residents -- about 13 percent of Michigan's population -- are uninsured.

A state-operated plan would be more tailored to Michigan's needs, said Shelly Edgerton, deputy director of the state Department of Licensing and Regulatory Affairs.

"With a state plan you have the ability to control your own markets," she said. "It's always better to have ... Michiganders doing what's best for our own state versus having the feds come in and direct us to do it in a certain way."

The Michigan League for Public Policy, a nonprofit advocacy group, on Tuesday urged the House to join the Senate in approving a state exchange.

Haines said her committee's hearings on the matter had raised many unanswered questions about operating a state exchange, including its cost and how it would differ from a federal program.

"There are a lot of possible unintended consequences," said Haines, a Republican from Lake Angelus. "I think we've been very prudent to move at the snail's pace that some people would say we've moved at."